中老年2型糖尿病人群GDF15水平与颈动脉斑块稳定性的相关性研究

Study on correlation between GDF15 level and carotid arterial plaque stability in middle age and elderly people with type 2 diabetes mellitus

目的研究中老年2型糖尿病(T2DM)人群血清生长分化因子(GDF15)水平与颈动脉斑块形成及斑块稳定性的关系,探索中老年2型糖尿病人群GDF15与心血管疾病的相关性。方法选取2017年11月至2018年10月合格中老年住院人群90例作为研究对象,按照颈动脉斑块B型超声结果分为无斑块组(30例)、1个斑块组(28例)、>1个斑块组(32例);依据B型超声观察颈动脉斑块特征,将斑块组分为稳定斑块组(37例)和不稳定斑块组(23例),无斑块组30例。比较各组之间GDF15水平和生化指标差异,采用有序回归及Logistic回归分析影响斑块数量和稳定性的因素,计算比值比(OR)和95%可信区间(95%CI)。结果>1个斑块组GDF15水平[(1108.95±543.15)pg/mL]均高于1个斑块组[(876.02±264.7)pg/mL]和无斑块组[568.81±324.81)pg/mL](P<0.01);将GDF15四分位分组,以无斑块组为参比,调整相关因素后,25~50分位、>50~75分位、>75分位区段人群与25分位以下区段人群比较,颈动脉斑块数量升高一个等级的OR值分别为4.212(95%CI:1.133~15.642)、15.518(95%CI:3.947~61.007)、13.599(95%CI:3.059~60.461);不稳定斑块组GDF15水平[(1244.61±596.17)pg/mL]高于稳定斑块组GDF15的>50~75分位、75分位以上区段GDF15人群[(848.35±223.71)pg/mL](P<0.01),发生不稳定斑块的OR值是25分位以区段下的12.277(95%CI:0.937~172.744)和31.937(95%CI:1.852~550.729)倍(P<0.05)。结论中老年T2DM人群GDF15水平与颈动脉斑块数量及斑块稳定性相关,高GDF15水平人群颈动脉斑块数量危险性增加,不稳定斑块危险性增加,GDF15水平可能与中老年T2DM并发心血管疾病有关,并可监测心血管意外情况发生。

Objective To explore the relationship between serum GDF15 level with carotid arterial plaque formation and plaque stability in middle age and elderly people with type 2 diabetes mellitus(T2DM).Methods Ninety eligible middle age and elderly inpatients in this hospital from November 2017 to October 2018 were selected as the study subjects and divided into the non-plaque group(30 cases),1 plaque group(28 cases)and>1 plaque group(32 cases)according the B type ultrasonic results of carotid arterial plaques.The plaque groups were divided into the stable plaque group(37 cases)and unstable plaque group(23 cases)according to the characteristics of carotid arterial plaques showed by B type ultrasound.The differences in the biochemical indicators and GDF15 were compared among the various groups.The ordinal regression and Logistic regression were adopted to analyze the plaques number and stability factors.The odds ratio(OR)and 95%CI were calculated.Results The GDF15 level in the>1 plaque group was higher than that in the non-plaque group and 1 carotid plaque group[(1108.95±543.15)pg/mL vs.(876.02±264.7)pg/mL vs.(568.81±324.81)pg/mL,P<0.01].GDF15 was grouped by quartile,the non-plaque group served as the reference,after adjusting the related factors,comparing the population in 25-50 quartile,>50-75 quartile and>75 quartile with the population<25 quartile,the OR values for the number of carotid arterial plaques increasing by 1 grade were 4.212(95%CI:1.133-15.642),15.518(95%CI:3.947-61.007)and 13.599(95%CI:3.059-60.461)respectively;the GDF15 level of the untable plaque group was higher than that of the stable plaque group in the intervals of>50-75 and>75 quartile[(1244.61±596.17)pg/mL vs.(848.35±223.71)pg/mL,P<0.01].The OR values for unstable plaque occurrence were 12.277(95%CI:0.937-172.744)and 31.937(95%CI:1.852-550.729)under the interval of 25 quartile(P<0.05).Conclusion The GDF15 level is related to the carotid plaque number and plaque stability in middle age and elderly peoples with T2DM.The risk of plaque number in the population with high GDF level is increased and the risk of unstable plaque is increased.The GDF15 level may be related complicating cardiovascular disease,which can monitor the occurrence of cardiovascular accidents.